Provider Demographics
NPI:1235348897
Name:ASSIAGO, MARCELLUS SAKA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCELLUS
Middle Name:SAKA
Last Name:ASSIAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3702 S STATE ST STE 107
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84115-5096
Mailing Address - Country:US
Mailing Address - Phone:801-288-2634
Mailing Address - Fax:801-288-1186
Practice Address - Street 1:12523 S CREEK MEADOW RD STE 111
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7291
Practice Address - Country:US
Practice Address - Phone:801-288-2634
Practice Address - Fax:801-288-1186
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT6856533-1205207RN0300X
NV13068207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology